The principles of treatment in hypernatremia are similar to those in hyponatremia and therefore it also important to determine:

Acute (< 24 hours) versus chronic (> 24 hours)

Acute: correct over 24 hours

Chronic: correct by 10mEq/24 hours

Why? With aggressive repletion of free water, there is a risk of cerebral edema. This risk is less than that of aggressive correction of hyponatremia (–> osmotic demyelination syndrome) but is more likely in patients with higher initial Na

Symptomatic versus asymptomatic

Details of correction of chronic hypernatremia

Step 1: use the (1) patients’ weight (2) current sodium and (3) goal sodium (usually 10mEq less than current sodium) to calculate the free water deficit for the day.

Step 2: divide the free water deficit/24 hours and infuse D5 H20 at that rate